Aya Mudrik BS , Romi Levy BS , Alessandro Petrecca MD , Moti Gulersen MD, MSc , Suneet P. Chauhan MD, Hon DSc , Offer Erez MD, MBA , Misgav Rottenstreich MD, MBA
{"title":"Guidelines on cerclage placement: a comparative systematic review","authors":"Aya Mudrik BS , Romi Levy BS , Alessandro Petrecca MD , Moti Gulersen MD, MSc , Suneet P. Chauhan MD, Hon DSc , Offer Erez MD, MBA , Misgav Rottenstreich MD, MBA","doi":"10.1016/j.ajogmf.2025.101727","DOIUrl":"10.1016/j.ajogmf.2025.101727","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Variability among professional society guidelines for cervical and abdominal cerclage may lead to inconsistent clinical practice and outcomes.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to systematically identify, summarize, and compare professional medical-society guidelines on cervical and abdominal cerclage.</div></div><div><h3>STUDY DESIGN</h3><div>Guidelines were independently screened and selected by 2 reviewers. Quality was assessed using the AGREE II instrument. Data were extracted into a standardized form and synthesized narratively, focusing on comparing recommendations regarding indications, contraindications, timing, technique, and perioperative management of cerclage placement.</div></div><div><h3>RESULTS</h3><div>Twenty guidelines from ten professional societies were included. Consensus existed on several key indications, including history-indicated cerclage for ≥3 second-trimester losses, ultrasound-indicated cerclage for cervical lengths under 10 mm, and abdominal cerclage in cases of prior transvaginal cerclage failure or insufficient cervical tissue. However, disagreements remain. For instance, ACOG (American College of Obstetricians and Gynecologists) recommends considering cerclage after one loss, whereas most guidelines require 3. There is also variation regarding the timing of physical examination cerclage beyond 24 weeks, with NICE (National Institute for Health and Care Excellence) extending the window to 28 weeks. Additionally, recommendations diverge on cerclage for prolapsed membranes, with some guidelines advising against the procedure due to a high risk of failure, while others support considering it.</div></div><div><h3>CONCLUSION</h3><div>Guidelines agree on history-indicated cerclage for ≥3 second-trimester losses, ultrasound-indicated cerclage for cervical lengths under 10 mm, and abdominal cerclage in cases of prior transvaginal cerclage failure or insufficient cervical tissue. While agreement exists on key indications and contraindications, notable divergences remain in certain recommendations. This review emphasizes the need for congruent recommendations to enhance consistency.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 9","pages":"Article 101727"},"PeriodicalIF":3.1,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Giulia Bonanni MD , Vivian Nguyen , Marta Francescutti , Alireza A. Shamshirsaz MD , Vincenzo Berghella MD
{"title":"Subcutaneous tissue closure and postoperative wound complications in cesarean delivery: a systematic review and meta-analysis","authors":"Giulia Bonanni MD , Vivian Nguyen , Marta Francescutti , Alireza A. Shamshirsaz MD , Vincenzo Berghella MD","doi":"10.1016/j.ajogmf.2025.101724","DOIUrl":"10.1016/j.ajogmf.2025.101724","url":null,"abstract":"<div><h3>Objective</h3><div>The benefit of subcutaneous tissue closure during cesarean delivery (CD) has been well established in pregnant individuals with a subcutaneous tissue thickness greater than 2 cm. However, its routine application in all pregnant individuals remains a contentious topic. This meta-analysis aimed to evaluate and quantify the effect of subcutaneous tissue closure compared to nonclosure on postoperative wound complications in all patients undergoing CD.</div></div><div><h3>Data Sources</h3><div>We searched PubMed, EMBASE, Web of Science, Medline, Scopus, Cochrane Central Register of Clinical Trials, and ClinicalTrials.gov from their inception to October 2024 for randomized controlled trials (RCTs).</div></div><div><h3>Study Eligibility Criteria</h3><div>Eligible studies included RCTs comparing subcutaneous tissue closure vs nonclosure in patients undergoing CD. Studies were excluded if they focused solely on selected subpopulations, such as pregnant individuals with subcutaneous fat >2 cm or those classified as obese. Primary outcomes were seroma formation, hematoma, surgical site infection (SSI), and wound dehiscence. Secondary outcomes included postoperative pain and cosmetic results.</div></div><div><h3>Study Appraisal and Synthesis Methods</h3><div>Random-effects models were used to calculate relative risks (RR) for each outcome. Heterogeneity across studies was assessed using the I² statistic.</div></div><div><h3>Results</h3><div>Eight trials comprising 1854 participants (918 closure, 936 nonclosure) met inclusion criteria. There were no significant differences between groups for SSI (RR 0.95, 95% CI: [0.69–1.31]), dehiscence (RR 0.64, 95% CI: [0.21–1.98]), seroma (RR 0.87, 95% CI: [0.05–14.81]), hematoma (RR 0.54, 95% CI: [0.02–15.90]), or composite wound outcomes (RR 1.05, 95% CI: [0.80–1.38]). Study heterogeneity was low (I²<45%).</div></div><div><h3>Conclusions</h3><div>Subcutaneous tissue closure during CD does not significantly reduce the risk of wound complications when applied universally. These findings do not support its routine implementation for all patients with subcutaneous thickness less than 2 cm. Further research should focus on refining patient selection criteria and evaluating other potential benefits, including long-term cosmetic outcomes.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 9","pages":"Article 101724"},"PeriodicalIF":3.8,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Letter to Editors: systematic review on music interventions during pregnancy in favor of the well-being of mothers and eventually their offspring.","authors":"Can Ata, Benil Nesli Ata","doi":"10.1016/j.ajogmf.2025.101726","DOIUrl":"10.1016/j.ajogmf.2025.101726","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101726"},"PeriodicalIF":3.8,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dante Varotsis MD , Jordan Beacham BS , Julie Gomez MD , Zain Hannan BA , Rupsa C. Boelig MD , Vincenzo Berghella MD , Moti Gulersen MSc
{"title":"Stillbirth is associated with postpartum severe maternal morbidity compared with gestational age matched and term live births","authors":"Dante Varotsis MD , Jordan Beacham BS , Julie Gomez MD , Zain Hannan BA , Rupsa C. Boelig MD , Vincenzo Berghella MD , Moti Gulersen MSc","doi":"10.1016/j.ajogmf.2025.101725","DOIUrl":"10.1016/j.ajogmf.2025.101725","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>The rates of severe maternal morbidity in the United States continue to increase. The American College of Obstetricians and Gynecologists recommends close postpartum follow-up for patients at increased risk for severe maternal morbidity and mortality, such as those who suffer from preeclampsia or hypertension. Data on the association between stillbirth and severe maternal morbidity are limited.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to evaluate the association between stillbirth and severe maternal morbidity in comparison with gestational age–matched and term live births.</div></div><div><h3>STUDY DESIGN</h3><div>This was a multicenter, retrospective cohort study that was performed at 3 centers within a hospital system from 2017 to 2023. Severe maternal morbidity was defined with guidance from the indicators outlined by the Centers for Disease Control and Prevention. The inclusion criteria for the stillbirth group were delivery of a fetus that showed no signs of life at 20 weeks’ gestation or later. Cases with antepartum preeclampsia, multiple gestations, maternal age less than 18 years, duplicate records, and voluntary terminations of the pregnancy after 20 weeks’ gestation were excluded. We selected gestational age- and term-matched live births as the control groups. A logistic regression analysis was performed to evaluate the odds of the composite severe maternal morbidity in stillbirths vs gestational age–matched and term-matched live births, separately, with adjustment for potential confounders. The data were presented as the adjusted odds ratios with 95% confidence intervals, and statistical significance was set at a <em>P</em> value of <.05.</div></div><div><h3>RESULTS</h3><div>Of the 29,060 deliveries during the study period, there were 129 (0.44%) stillbirths. Stillbirth was associated with significantly higher odds of severe maternal morbidity than term (adjusted odds ratio, 4.35; 95% confidence interval, 1.75–10.84) and gestational age matched livebirths (adjusted odds ratio, 3.39; 95% confidence interval, 1.72–6.66). There was no significant difference in the rate of postpartum hemorrhage when stillbirths were compared with gestational age–matched live births (10.1% vs 7.3%; <em>P</em>=.42), however, there were significantly more transfusions needed in the stillbirth group (10.1% vs 1.6%; <em>P</em>=.017). When compared with the term live births, there were significantly more transfusions (10.1% vs 1.6%; <em>P</em><.001), intensive care admissions (2.3% vs 0%; <em>P</em>=.007), postpartum preeclampsia (2.3% vs 0%; <em>P</em>=.007), and sepsis (2.3% vs 0%; <em>P</em>=.007).</div></div><div><h3>CONCLUSION</h3><div>Stillbirth is associated with an increased risk for severe maternal morbidity when compared with gestational age- and term-matched live births. Increased postpartum surveillance should be implemented into practice, and preventative interventions, such as tranexamic acid admin","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 9","pages":"Article 101725"},"PeriodicalIF":3.8,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144294999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Julia Whitley MD, Karen George MD, MPH, Jeannie C. Kelly MD, MS, Megan L. Lawlor MD, Erika Banks MD, Phillip Ma MD, Jillian Catalanotti MD, MPH
{"title":"The state of residency training in treatment of opioid use disorder in obstetrics and gynecology","authors":"Julia Whitley MD, Karen George MD, MPH, Jeannie C. Kelly MD, MS, Megan L. Lawlor MD, Erika Banks MD, Phillip Ma MD, Jillian Catalanotti MD, MPH","doi":"10.1016/j.ajogmf.2025.101723","DOIUrl":"10.1016/j.ajogmf.2025.101723","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 8","pages":"Article 101723"},"PeriodicalIF":3.8,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Letter in reply re: comparative effectiveness of low molecular weight heparin on live birth for recurrent spontaneous abortion: systematic review and network meta-analysis","authors":"Wenrui Huang MD, PhD, Xuelian Du MD, PhD","doi":"10.1016/j.ajogmf.2025.101720","DOIUrl":"10.1016/j.ajogmf.2025.101720","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 8","pages":"Article 101720"},"PeriodicalIF":3.8,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Neha Agarwal MD, Edgar Hernandez-Andrade MD, PhD, Baha M. Sibai MD, Farah H. Amro MD, Jennie O. Coselli MD, Michal F. Bartal MD, Dejian Lai PhD, Eleazar E. Soto-Torres MD, Sami Backley MD, Anthony Johnson DO, Jimmy Espinoza MD, MSc, Eric P. Bergh MD, Sen Zhu PhD, Ashley Salazar DNP, Sean C. Blackwell MD, Ramesha Papanna MD, MPH
{"title":"Letter in Reply Re: Quantifying placenta accreta spectrum severity and its associated blood loss: a novel transvaginal ultrasound scoring system","authors":"Neha Agarwal MD, Edgar Hernandez-Andrade MD, PhD, Baha M. Sibai MD, Farah H. Amro MD, Jennie O. Coselli MD, Michal F. Bartal MD, Dejian Lai PhD, Eleazar E. Soto-Torres MD, Sami Backley MD, Anthony Johnson DO, Jimmy Espinoza MD, MSc, Eric P. Bergh MD, Sen Zhu PhD, Ashley Salazar DNP, Sean C. Blackwell MD, Ramesha Papanna MD, MPH","doi":"10.1016/j.ajogmf.2025.101722","DOIUrl":"10.1016/j.ajogmf.2025.101722","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 8","pages":"Article 101722"},"PeriodicalIF":3.8,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Songjie Liao MD, Di Xiao MD, Yaling Li MD, Liqiu Kou MD
{"title":"Letter to the editor regarding “Breast stimulation vs low-dose oxytocin for labor augmentation in women with a previous cesarean delivery: a randomized controlled trial”","authors":"Songjie Liao MD, Di Xiao MD, Yaling Li MD, Liqiu Kou MD","doi":"10.1016/j.ajogmf.2025.101717","DOIUrl":"10.1016/j.ajogmf.2025.101717","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 9","pages":"Article 101717"},"PeriodicalIF":3.1,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Unwanted pregnancies are associated with preterm birth, but not low birth weight","authors":"Annie Dude MD, PhD , Jocelyn Wascher MD","doi":"10.1016/j.ajogmf.2025.101713","DOIUrl":"10.1016/j.ajogmf.2025.101713","url":null,"abstract":"<div><h3>Background</h3><div>Prior studies indicate that unintended and unwanted pregnancies can be associated with poor obstetric outcomes.</div></div><div><h3>Objective</h3><div>This study examined whether an unintended or unwanted pregnancy was associated with a preterm delivery and with low birth weight.</div></div><div><h3>Study design</h3><div>We conducted a secondary analysis of the 2017 to 2019 cycle of the National Survey of Family Growth, a nationally-representative population- based survey of reproductive-aged people identifying as female in the United States. The sample consisted of respondents who had at least one prior live birth. Respondents were asked whether their most recent pregnancy was wanted (either at that time or prior to that time), unintended (wanted, but too soon, or unwanted at any time), or unwanted (did not want to be pregnant at any time). The primary outcomes were preterm delivery, defined as a live birth prior to 37 weeks’ gestation, and low birth weight, defined as a birthweight less than 2500 grams. We also examined early preterm delivery (defined as a live birth prior to 34 weeks’ gestation) as a secondary outcome, as well as restricting the sample to term deliveries only to examine low birth weight. We used chi square and Wilcoxon rank sum analysis for bivariable comparisons and logistic regression for multivariable models.</div></div><div><h3>Results</h3><div>Our sample consisted of 3299 unique deliveries, 35.4% of which resulted from unintended pregnancies and 16.9% of which resulted from unwanted pregnancies. Overall, 12.7% of respondents had any preterm delivery, including 11.3% of those with intended pregnancies, 15.4% of those with unintended pregnancies (<em>p</em>=.02), 11.9% of those with wanted pregnancies and 16.9% of those with unwanted pregnancies (<em>p</em>=.01). Of the overall sample, 3.7% had a preterm delivery prior to 34 weeks gestation, including 3.0% of those with an intended pregnancy, 4.9% of those with an unintended pregnancy (<em>p</em>=.10), 3.1% of those with wanted pregnancies, and 6.3% of those with unwanted pregnancies (<em>p</em>=.01). Unwanted pregnancies remained associated with preterm delivery and early preterm delivery after adjusting for confounders (adjusted odds ratio 1.42, 95% confidence interval 1.02 to 1.98 for any preterm delivery, adjusted odds ratio 1.84, 95% confidence interval 1.10 to 3.08 for early preterm delivery). In our sample, 8.0% of respondents had a low birth weight neonate, including 6.6% of those with an intended pregnancy, 10.5% of those with an unintended pregnancy (<em>p</em>=.02), 7.4% of those with wanted and 10.5% of those with unwanted pregnancies (<em>p</em>=.10). These results were insignificant among those with term deliveries and after adjusting for confounders.</div></div><div><h3>Conclusion</h3><div>Unwanted pregnancies are associated with an increased risk of preterm delivery, but not low birth weight.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 8","pages":"Article 101713"},"PeriodicalIF":3.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}